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other, temperature 96.5°, pulse 44. In both there were evidences of great prostrationlabored breathing, blue lips, distress of countenance, body bathed in profuse cold sweat. The temperature, which had been from three to four degrees above normal during the grip, dropt to subnormal when the pneumonia appeared, and remained so thruout the attack -about ten days. Both cases were treated with stimulants, strychnin, concentrated nourishment, etc. Both recovered. Neither was blistered.
In puerperal septicema I have gotten fine results from applications of tr. iodin to the uterus and vagina. The uterus should be well swabbed out with the iodin, a pledget of absorbent cotton on the long handle uterin dressing forceps making a good applicator. The iodin may be applied again in twenty-four hours, but in less quantity. Then wait two or three days before applying again. I have seen a temperature of 105.5° fall to a 101° in twelve hours, with decided improvement in all the conditions. So far it has given me better results than any remedy I ever used, recovery following every case where used. I have recently treated a case, in consultation, complicated with severe nephritis (Bright's), which was present before confinement, with entirely satisfactory results. Of course there should be care and judgment in the use of the iodin. In some patients its use may be followed by uterin colic, tho I have seen nothing of the kind in any of the cases treated by me. The iodin should be applied only to diseased surface. Usually it need be applied but once to the inside of the uterus, other applications being made only to cervix. and posterior vagina. The use of the iodin does not exclude such other treatment as may be required in each individual case.
GAVIN RAWLS, M.D.
Eclectic Remedies in Pneumonia. Editor MEDICAL WORLD:-The remarks by J. C. Mitchell, M.D., page 12, January WORLD, on pneumonia, it seems to me can scarcely be supported by facts or the experience of others of that school. He says: "Any eclectic that doesn't abort or cure every case of pneumonia in from thirty-six to seventy-two hours should study his drugs more carefully." If the Doctor's experience with the remedies mentioned by him have given him such favorable results in the treatment of pneumonia as the above remarks would indicate, it may be that his experience with this disease has been very limited. While I believe, with the Editor and the vast majority, that pneumonia is a selflimited disease, I also believe at the same time that proper treatment may mitigate and sometimes shorten the duration of the disease. Ac
onite, veratrum, belladonna, bryonia, gelsemium, etc., are all excellent remedies, but they will not cut short every case of pneumonia by any means. I speak from experience, and I may add that I am a graduate of an eclectic as well as an allopathic school. I do not deny that it is even possible to abort (socalled) pneumonia if treatment is begun at once. To illustrate: I was called not long since to see a patient whose trouble began with a hard chill with febril reaction, and whose lungs at the time of my arrival were very much congested. I gave sp. tr. veratrum and bryonia with excellent results, and within two days the patient was as well as usual. Had this case been neglected it might have terminated in pneumonia. I don't know. know. What I do know is that at the time of treatment it was not a case of pneumonia, but one of acute congestion, with threatened pneumonia which never developt.
In closing, I desire to say that in the beginning of a case of pneumonia I invariably give the remedies the Doctor has mentioned as specifically indicated, and follow them up as my judgment tells me. If the Doctor can have his patients run thru the three stages of pneumonia in two or three days to recovery, he is more successful with the remedies mentioned than I have ever been, or ever hope to be. Buckley, Ills. O. L. THOMPSON, M.D.
Antiseptic Treatment of Pneumonia. Editor MEDICAL WORLD:-Some time ago you askt what we were going to do for our pneumonia patients this winter. Nine physicians from New York, Tennessee, Texas, Oregon, Illinois, and Colorado, answered in the November and December issues of THE WORLD. Only two of them made any reference to this as a germ disease, and but one entertained anything like an antiseptic and eliminativ theory for its treatment. This apparent indifference or lack of knowledge of the true cause and proper treatment of this disease causes me to ask, "Mr. Bacteriologist, where are we at?"
Since this disease is caused by a pneumonic germ, the most rational treatment for its cure is to remove the germs; hence, the antiseptic and eliminativ treatment. The most of the nine physicians gave their treatment in detail, which was very similar, and is rather obsolete
with me at least. One says, "I shall use belladonna, bryonia, aconite, arnica, acetanilid, and gelsemium, as indicated, and expect to get along without any trouble, as in the past, and I have handled the disease at an altitude of 10,500 feet."
He does not say how long he has practised, or how many cases he has so treated. I cannot understand how these remedies have been so successful in his hands and in such a high alti
tude. I have used for the last four years in ordinary cases, where there is nothing in the condition of the patient that contra-indicates their use, mild chlorid of mercury and bicarbonate of soda, equal parts; carbonate of creosotal; ergot; urotropin; antiphlogistine; and nitroglycerin compound (tablet triturates No. 618, by Parke, Davis & Co.). In the thirty-six years I have practised medicin I have found nothing that equals these in the treatment of pneumonia. W. O. WRIGHT, M.D.
Criticism. - How I Handle Some Difficulties in Labor. Editor MEDICAL WORLD:-In the December WORLD, page 551, under the caption "There should not be over three percent of deaths in Pneumonia," the Doctor proceeds to give his treatment as follows: A cathartic with sufficient calomel to move the bowels freely, then sodium salicylate, 5 grains, citrate of potash, 10 grains, at one dose every two hours, in water, with aromatic spirits of ammonia. To this he says may be added aconite or veratrum in small doses, but enuf to reduce the pulse in frequency. He also begins with strychnin, or grain every two hours. Now, Mr. Editor, I would like to ask him why he gives the aconite or veratrum to reduce the pulse-the force of the circulation-and then gives the strychnin, % to a grain every two hours. It does seem to me that he certainly crossfires in his treatment, besides the damage he may do by beginning so early with his strychnin. I have learned that a good general holds some of his forces back in reserve, to reinforce as the fight progresses. There is no doubt but that strychnin given at the proper time and in the proper dose is all right; but it does seem to me that even at the proper time, when needed, that or even grain every two hours is dosing a little heavy. And again, sulfo-carbolate of zinc is all right in typhoid fever in proper doses, but I never have seen a case of pneumonia that I thought would be benefited by its administration. What say others? He does not use opiates for pain and restlessness. The hot water or hot poultice of flaxseed is all right, but what is the matter with Dover's powders, say 21⁄2 to 3 grains, repeated often enuf to ease pain and quiet the patient, thereby giving him needed rest and sleep? The hypodermic of cold water might do if the patient had hysteria, but where there is real pain and suffering, to my mind it would not count for much. Or if he objected to Dover's, what would be the objection to papine, enuf to ease the pain?
He says he bases his treatment on salicylate, potassium citrate and strychnin, basing his
theory on uric acid as a cause of the inflammation. My dear brother, the books give pneumococci as the cause of pneumonia, and not uric acid.
Now as to his deathrate-3 percent in 106 cases, from 6 months to 84 years old. This is certainly a remarkable record; but I am constrained to think that our brother has been mistaken as to diagnosis in many of his cases. Has he not fallen into the habit of many physicians of calling every case typhoid or pneumonia when it is prevalent? I have known doctors to say, "My dear sir, your little girl has a bad case of typhoid fever," and inside of three or four days she was out playing as usual.
If you will pardon me I will write a little from experience that I have never seen in books or heard in a lecture: I have often had cases of confinement where the patient progrest slowly until the head of the child passed thru the upper strait and imbedded itself in the hollow of the sacrum, and hung there for hours without making perceptible progress. Well, after turning the patient on her side, and having her get up and walk around, without doing any good, I then get a chair and have the husband sit down in it, spread an old dress or something over his lap, and have the patient get up and sit astride his lap, facing him (not an elegant position), and have the husband lock his arms around her back, and have her to put her arms around over his shoulders and grasp the back of the chair, and when she has a pain have both to tighten their grasp and pull together, and my brothers, you will be agreeably surprised to see how quickly the head of that baby will proceed on its journey. And when the head begins to press against the perineum considerably, I take hold of the shoulders of the patient and have the husband to take hold around the thighs and raise up, and we lay the patient easily in bed, and then a few more pains will certainly end the birth. Now, please don't lean back and laugh, but try in the very next case you have and see the results.
And again, you all, no doubt, have had cases of primiparas where the parts were constricted, perineum rigid, with the labia majora and labia minora constricted, and with the peculiar oval or egg shape of those muscles with the pointed or smaller part up, the muscles very tense and forcing the head of the child down against the perineum. Then there is great danger of rupturing the perineum. What do I do? Why, I have on several occasions used a small, pointed pair of scissors or a sharp-pointed bistoury and divided the labial muscle, say an inch or an inch and one-half below its attachments above-and it will surprise you to see how it will relieve the very tense perineum, and
likely with the very next pain the head will be born, and with little or no laceration; and you will feel good and congratulate yourself on having done some good for once by decisiv action. You may say the patient and husband will object. It can be easily explained to parties of intelligence, and they will agree to let you do what you think best. Corydon, Ind. Z. T. FUNK.
Influence of the Mother on the Fetus.-An Obstetrical Record.
Editor MEDICAL WORLD:-For years I have noticed an annual crop of articles in the different medical journals regarding the probability or even possibility of a pregnant woman marking her fetus in utero thru her mental impressions. Why this question has not long ago been settled affirmativly, I fail to comprehend. It may not be amiss for me to contribute my "mite" toward the settling of the question. Fifty-two years ago, when I was yet in Vienna, Austria, a lady friend of the family called one day in a very excited condition, stating that she just came from the house of a friend, where she saw the horrible sight of a boy fourteen years of age, who was kept in a separate room, on the floor, as he was helpless, having no legs. And she remarkt excitedly that if she had such a creature, she would throw him into the Danube. In seven or eight months she gave birth to just such a creature, but she failed to throw him into the Danube. During our Civil war a young man decided to enlist as a volunteer; his married sister became enraged over it, and she said to him and to all neighbors, that she hoped that his legs would be shot from under him. In due time she gave birth to a girl without legs (!); but the brother returned with his legs. Mother and daughter are still living. I was attending a case where, as the child was emerging from the vulva as fast as the pressure was removed, a horrible mass sprang up, which extended from the neck (covering the whole back) to the nates. I had seen several rose cancers, and this mass at once reminded me of one. The child was still-born. The mother knew that one of her sisters in Maine was slowly dying of a cancer, but the knowledge of the site of it was kept from her, so she should not mark her child. She continually worried about that sister. One time, as I entered the sickroom, I found my patient in the third stage of labor, and, of course, I at once devoted myself to my duty. When the child was born, I observed a perfect blister extending across the whole wrist, the fluid distending it as much as possible. When I exprest surprise, the mother held up her arm, which was bandaged around the wrist, and which I had not had a chance to notice before;
she explained that the day before she burned a blister on her arm, on the stove pipe. At one time, as soon as the child was born, I noticed that it held its hands turned outward; the next day this was more pronounced, and the toes pointed downward; the day following the sternum was bulging forward, appearing like what is called a "pigeon breast; in three months all the joints were stiff; the diameter from axilla to axilla was two and one-half inches, and from sternum to spinal column seven and one-half inches. The face was beautiful, with a sad expression. It then died. The mother had during the last three months of pregnancy worried about a child in just such condition, which also died at six months. My sister-inlaw gave birth to a child that was covered with black, confluent smallpox; a short time before confinement she visited a relativ who was just breaking out with that disease. She was greatly frightened, but she never had any symptom of the disease. After I had confined a certain woman six or seven times, with wellformed, healthy children, I was surprised at the next birth to find upon digital examination the strangest presentation I ever felt, and to my consternation there issued forth a perfect rat's head, but the body was perfectly human. The mother had a terrible fright at a rat when she was not yet aware of her pregnant condition.
The above citations ought to be sufficient to convince any skeptic on the subject. And do we not find in the Bible, thirtieth chapter of Genesis, that nature's law was well understood by Jacob, when he took rods of green poplar and peeled them in part, so as to show streaks of white and green, and put them in the watering troughs of the flocks, to make them bring forth striped and spotted young, which they did? But what is of much greater importance, and which I have seen verified many times, by observations of many years, is the power of a mother's thoughts over the mental development of her offspring. Aside from all ancestral inheritance of characteristics which will crop out, the main line of deportment is markt out by the mother during pregnancy. I know a woman, whose husband gratified her every wish; she had privileges in a number of large stores in New York City, but during pregnancy she developt a seeming uncontrolable kleptomania, which caused her and her husband great trouble and expense. The child of that pregnancy proved herself an unmitigable petty thief. Right here I will state that I had a patient brought to me afflicted with kleptomania; she had an abortion produced in New York City, which left her uterus in a deplorable state; her petty thefts caused her husband an expenditure of thousands of dollars. As her uterus improved under treatment, she lost her unfor
tunate tendency to steal. This case helps to show how much control the state of the uterus exercises over a woman's mental and physical condition.
I could cite hundreds of cases, as I have been a close observer since 1856. I had over 400 obstetrical cases before we had a medical college for women in New York City. During the war I labored among the sick soldiers where my husband, Dr. G. B. Hammond, was surgeon; then I attended college; graduated in 1867, and then went headlong into obstetrics and diseases peculiar to woman's organs. Since graduation I have ministered to over 2,000 obstetrical cases. I have never to this hour lost a woman in the lying-in state; have never used instruments, and have never been obliged to take a stitch for laceration. The smallest babe weighed one and onehalf pounds. She is now a school teacher in Brooklyn. The largest weighed twenty pounds; it was still-born. My youngest patient was twelve years and ten months of age-a case of incest. My oldest patient was fifty-six years of age. Since six months ago I declined obstetrical cases, as, at my age, I fear I cannot do full justice to cases. I have had many narrow escapes from calamity.
GERTRUDE HAMMOND HARPER, M.D. Spring Valley, N. Y.
Deformity of Sexual Organs, and Absence of Anus.
Editor MEDICAL WORLD:-Father age 38, in excellent health, history of having several years since drank to excess, all other history negativ. Mother age 36, II-para; of an energetic, domineering disposition. Subject to occasional cramping of extremities, but has had no attack since carrying the unfortunate child which is the subject of this article.
A child weighing five pounds was delivered in normal labor at term. As is too frequently a habit with physicians, I handed it over to a nurse with only a glance to ascertain its sex. I announced the arrival of a girl. The old lady not seeing well, overlookt, as I did, that a divided scrotum and mal-formed penis covered with vernix caseosa had been mistaken for labiae and clitoris. Subsequent ex. amination showed that the child urinated from what would be the normal position of the female urethra, and the penis has no urethral opening whatever. This penis is short and stubby, and the glans is almost entirely exposed, and is capable of being fully so. Beneath the urethral opening is a small triangular space into which I inserted small probe. It is apparently a mucous opening, but not sufficiently well defined to warrant me in believing that Nature tried to make a
vagina. While I at first thought so, I now believe it is caused by the relativ position of the parts. In the right "labium" is a small glandular body which I pronounced a testicle. In the left one there was nothing. But when the child was some three weeks old the testicle on that side had arrived at a similar destination.
All this unfortunate state of affairs was not discovered until the second day, when the nurse found that, as she exprest it, "the baby's got no rectum." There is absence of anus, not even a dimple where it should be. I advised the parents that an incision could be made over the proper location, but they objected. After two days' crying, and of course much suffering, a false opening occurred, too much anteriorly and to one side of the raphe. Thru this opening the bowel empties itself, the napkin being always soiled.
With all its misfortunes, small, delicate and puny, this child proposed to live, which it has a perfect right to do, and is now two months old and very thrifty.
Now, what are we to learn from the foregoing?
The first deformity is a variety of hypospadias, of which there are three: (1) balanic, those terminating in the glans; (2) penile, those terminating anywhere along the pendulous urethra; (3) perineal, those terminating at some point in the perineum. My case seems nearer the last named variety, or rather a peno-scrotal one. Descriptions of operations for these conditons are to be found in works on surgery. In this case I doubt the successful repair of these parts, because of the distant removal of the penis from the present urethral opening.
The fistulous anus, is, if possible, a more unfortunate defect than the sexual. This deformity is said to occur once in some 4,588 cases. The congenital absence of anus is divided into three varieties: (1) narrowing, or partial occlusion; (2) total occlusion; (3) complete absence. My opinion is that this is one of the third classification-that of complete absence. The presumption is that the bowel contents opened in the direction of least resistance. For this to accomplish, the muscles in that region must of necessity have been very easily divided, and that there are no sphincter muscles is evidenced by absence of control of feces.
Gray gives a very comprehensiv description of the formation of these structures, which takes place between the third and fourth months of gestation, a variation from which results in a deformity, notwithstanding the belief in a special providence on the part of many of the laity.
I am deserving of criticism for not ascertaining for sure the sex of the child, and the existence of any deformity; but I promise to do better in the future. However, in this instance, I believe it is fortunate that the arrival of a "girl" was announced, for social and cosmetic reasons. It is obvious that the child can better get thru the world as a "girl," at least until the age of puberty. few years hence an operation on the anus may be had, and in the event sphincter muscles are found, the child may yet be able to lead a useful life. CHAS. W. MCMILLAN.
Ada, Indian Territory.
Was it Diaphragmatic Pleurisy.
Editor MEDICAL WORLD:-Leo. G., age 13. Shortly after midnight on December 7, awoke with stomach ache, which soon passed away. Ate breakfast in morning and went to school in forenoon; ate only a little dinner and remained at home in afternoon, because of nausea and abdominal pain.
I saw him at 8 p. m. December 8. Temperature 101°, pulse 110; right abdominal muscles tense, tenderness over cecum and quite severe pain. No cough; no symptoms of cold; respiration normal. Diagnosed appen. dicitis. Gave calomel which moved bowels next morning, and applied cloths wrung out of hot infusion of smart weed; ordered no feeding and no cathartics. December 9, gave some morphin for pain, and nutrient enemata of peptonized milk. This treatment was continued for six days, tho but little of the opiate was given. There was then no pain, some tenderness, and temperature which had been from 103° to 104.4° dropt to 101°. No tumor palpable, percussion normal in iliac region. Continued rectal feeding, but temperature came up and ranged between 100° and 103.2° for six days. No chilly sensations, no sweating; felt good, good color, little emaciation.
At 10 p. m. December 20, was called to see him. For first time he was coughing and expectorating; sputum was fecal in odor; respiration very rapid. Examined right chest and found signs of fluid, low in axillary region; hepatic dulness obliterated. In two hours became cyanotic, limbs cold, respiration 70, pulse 130 temperature 103°. Inserted trocar and drew off1⁄2 pint pus, thin, horribly offensiv and brownish in color. This relieved him considerably.
December 21 a surgeon was called in consultation. He said wait a day or two before operating in hope that he would be stronger, when a rib resection would be done.
At 6 p. m. December 21 he again began coughing, extreme dyspnea, cyanosis. I offered to do the rib resection but offered little
hope as to its avail. Penciled skin with 95 percent carbolic acid and used cocain spray for deeper tissues; took out one inch of rib and put in rubber drain. Some pus came out; but little relief was afforded.
He died three hours after operation. Consultant favored diagnosis of diaphragmatic pleurisy. Am very anxious to get opinion of some of the brothers, including Editor.
Rosendale, Wis. CHAS. A. DEVOE, M.D. [The condition of the right inguinal region seems to have been lost sight of late in the case. A post mortem should have been held. Early in the case more drainage by way of the bowels, particularly with castor oil, would have been an advantage, and also the use of intestinal antiseptics. We do not see the need or reason for feeding by the bowel; and why was it continued so long? The thoracic difficulty seems to have been of late development. Only a post mortem could have settled the diagnostic point.-ED.]
Nourish Your Typhoid Patients. Editor MEDICAL WORLD:-I have been practising ten years; have treated three hundred and fourteen cases of typhoid fever, and have not lost a single case. The thing to do in typhoid fever is, keep down fever and nourish your patient well. I direct nurse to sponge patient when temperature goes above 102°. The sponging will reduce the fever from one to two degrees. I give but little medicin. Something to keep skin acting well is important to keep down the temperature. Nourish your patients well. I give broths of all kinds with oyster crackers and soda crackers in them in a directed quantity; also a soft boiled egg three times daily, and oysters, corn starch and rice. The majority of physicians put their patients on a milk diet. I don't ask my patient to take milk. I ask them to drink water freely, also lemonade and chocolate. Nourish your patients, and when the fever leaves them there is sufficient strength left to enable them to get well. There is a large percentage of deaths in typhoid fever caused by physical exhaustion after temperature goes down to normal. They have been starved to death. My patients do not have the ravenous appetite that you find where they have been starved. I give solid food four days after the fever leaves them. I never had a case of hemorrhage of the bowels. I never had a patient in bed longer than twenty-four days. Nourish your patients and do it well. J. L. THOMPSON, M.D.
Limestone, Pa. [Doctor, how about all your cases having been genuin typhoid? Thirty-one cases of genuin typhoid per year for the first ten years is a pretty high average. Have not many of